Basic Information
| Provider Information | |||||||||
| NPI: | 1952425100 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MODERN RADIOLOGY,PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7346 | ||||||||
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| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007327346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878411949 | ||||||||
| FaxNumber: | 7878120565 | ||||||||
| Practice Location | |||||||||
| Address1: | 9176 CALLE MARINA | ||||||||
| Address2: | |||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007171582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878431625 | ||||||||
| FaxNumber: | 7878431723 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 01/19/2010 | ||||||||
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| AuthorizedOfficialLastName: | BERMUDEZ-RUIZ | ||||||||
| AuthorizedOfficialFirstName: | GAMALIER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7878431625 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | 4816 | PR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Body Imaging |
No ID Information.